PainRelief.com Interview with: Eric C. Schwenk MD Anesthesiology Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, Pennsylvania
Dr. Schwent
PainRelief.com: What is the background for this study? What are the main findings?
Response: Patients with refractory chronic migraine (rCM) have typically failed all available medications and many times have nearly constant headache pain and in many cases disability. Aggressive treatment is indicated to provide relief and help break the cycle of pain.
Lidocaine infusions have been used for decades in various acute and chronic pain conditions, including complex regional pain syndrome and pain after surgery. At the Jefferson Headache Center lidocaine has been a mainstay of treatment for such patients for several decades but evidence supporting its benefits is scarce.
The main findings were that patients with rCM experienced acute relief at the end of the infusion and that some relief was sustained at 1 month, although the degree of pain relief faded over time. It was also well tolerated with nausea and vomiting occurring in 16.6% of patients and other side effects occurring less frequently.
PainRelief.com Interview with: Imanuel Lerman MD MSc Associate Professor Affiliate Electrical and Computer Engineering VA San Diego Healthcare System Center for Stress and Mental Health Center for Pain Medicine UC San Diego Health Qualcomm Institute California Institute for Telecommunications and Information Technology (Calit2)
Dr. Lerman
PainRelief.com: What is the background for this study? What are the main findings?
Response:Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions. There is extensive clinical literature that offers support for efficacy in chronic pain treatment for both Low frequency and High frequency based spinal cord stimulation. While Low Frequency SCS has been heavily examined since its inception, High Frequency SCS paradigms have recently been clinically approved.
Emerging preclinical work also show sex may alter certain immunological pathways that contribute to chronic pain. But to date few report have identified interactions between sex and SCS. Therefore, we aimed to fill this knowledge gap through a single site (University of California San Diego), large (n=237) retrospective (2004–2020) analyses that compared SCS paradigm Low vs High Frequency SCS, efficacy (pain relief and opiate sparing effects) across sex.
PainRelief.com Interview with: Allison Lee, MD, MS [she/her/hers] Associate Professor of Anesthesiology Division of Obstetric Anesthesia Officer of Diversity, Equity and Inclusion, Department of Anesthesiology Medical Director of the Margaret Wood Center for Simulation and Education Columbia University Medical Center New York, NY 10032
Dr. Lee
PainRelief.com: What is the background for this study?
Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:
Lower labor epidural rates, despite it being the most effective modality for pain relief.
Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
Worse management of pain after cesarean delivery
Given the importance of effective management of postdural puncture headache and in light of growing evidence of complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.
PainRelief.com Interview with: Tony Antoniou PhD Department of Family and Community Medicine Li Ka Shing Knowledge Institute St. Michael’s Research Institute
Dr. Antoniou
PainRelief.com: What is the background for this study?
Response: Acetaminophen is used by millions of people worldwide and included as an ingredient in hundreds of over the counter products for pain and the common cold. Accidentally taking more than the safe dose of the drug is therefore possible. This is important because taking too much acetaminopohen can lead to potentially serious and fatal liver injury.
In Canada, changes to acetaminophen product labels warning individuals of the risk of taking too much of the drug and letting consumers know that the product can take acetaminophen were made to try and prevent accidental overdoses. We studied whether these label changes had any impact on the number of people being hospitalized with accidental acetaminophen overdose over a 16-year period.
PainRelief.com Interview with: Donatella Bagagiolo Osteopath D.O. BSc. (Hons) Ost. Director of Research Department, Scuola Superiore di Osteopatia Italiana Torino Italy
PainRelief.com: What is the background for this study?
Response:Osteopathic medicine, depending on different legal and regulatory structures around the world, is a medical profession (e.g. USA), an allied health profession (e.g. UK) or a part of complementary and alternative medicine (e.g. Italy or France). Osteopathic medicine plays an important role primarily in musculoskeletal healthcare. In recent years, systematic reviews have been published to evaluate the clinical efficacy and safety of osteopathic medicine for conditions such as low back pain, neck pain and migraine. However, due to differences in methodologies and the quality of systematic reviews, no clear conclusions were achieved. The aim of our overview was to summarize the available clinical evidence on the efficacy and safety of osteopathic medicine for different conditions.
PainRelief.com Interview with: Ingrid Heuch MD, PhD Department of Research, Innovation and Education, Division of Clinical Neuroscience Oslo University Hospital, Norway
Dr. Heuch
PainRelief.com: What is the background for this study? What are the main findings?
Response: Low back pain represents a major health problem in today’s society. In this study more than 27 000 women aged 20-69 years were included in the Trøndelag Health Study, HUNT, in Norway. As in most population-based studies, women were more likely to be affected with chronic low back pain than men. Our study showed a U-shaped relationship between age at menarche (age at a woman’s first menstruation) and risk of low back pain, also after many years. Both women with an early or late age at menarche experienced higher risk of low back pain. Compared to women with menarche at age 14 years, menarche at age 11 years increased the risk by 32% and menarche at age 17 years by 43%. No association was found between age at menopause and risk of low back pain.
PainRelief.com Interview with: Mark W Werneke, PT, MS, Dip. MDT Net Health Systems, Inc. Pittsburgh PA
Mark W Werneke
PainRelief.com: What is the background for this study?
Response: Coronavirus pandemic (COVID-19) has had a profound effect on changing health care delivery systems and resulted in a rapid growth of telerehabilitation care models. In addition, patients experiencing chronic low back pain increased during the pandemic which was confounded by mandatory lockdowns and lack of physical activity. There is scant literature demonstrating telerehabilitation’s effectiveness and efficiency for patients with low back pain seeking rehabilitation services during COVID-19 pandemic compared to traditional in-person office visit care.
The primary aim of our study was to examine the association between telerehabilitation treatments administered during every day clinical practice and functional status, number of visits, and patient satisfaction with treatment result outcomes compared to in-person care observed during the height of the pandemic. Using Focus on Therapeutic Outcomes (FOTO) database, our sample consisted of 91,117 episodes of care from 1,398 clinics located in 46/50 US states. Propensity score matching analytics was used to match episodes of care with or without telerehabilitation and standardized differences (S-D) were used to assess whether successful matching between telerehabilitation and no-telerehabilitation subgroups allowed for valid outcome comparisons.
PainRelief.com Interview with: Lauren R. Gorfinkel MPH New York State Psychiatric Institute New York, NY Department of Medicine, University of British Columbia Vancouver, Canada
PainRelief.com: What is the background for this study?
Response: The opioid crisis has led to clear declines in opioid prescribing across North America, however, chronic pain remains an extremely common health problem with limited treatment options. This study was therefore interested in using nationally-representative data to find out whether alternative pain medications are growing more popular as opioid prescriptions decline.
PainRelief.com Interview with: Peggy Compton, RN, PhD, FAAN Professor and van Ameringen Endowed Chair Program Director, Hillman Scholars in Nursing Innovation Department of Family and Community Health University of Pennsylvania School of Nursing Philadelphia, PA 19104
Dr. Compton
PainRelief.com: What is the background for this study?
Response: Patients with substance use disorders are highly likely to leave the hospital against medical advice (AMA) or self-discharge, putting them at risk for poorer health outcomes including progressing illness, readmissions, and even death. Inadequate pain management is identified as a potential motivator of self-discharge in this patient population. The objective of these secondary analyses was to describe the association between acute and chronic pain and AMA discharges among persons with opioid-related conditions.
PainRelief.com: What are the main findings?
Response: The main findings were that 16% of the 7,972 admissions involving opioid-related conditions culminated in an AMA discharge, which was more than five times higher than in the general population. Self-directed discharge rates were positively associated with polysubstance use, nicotine dependence, depression, and homelessness. Among the 955 patients with at least one self-directed discharge, 15.4% had up to 16 additional self-directed discharges during the 12-month observation period. Those admitted with an acutely painful diagnosis were almost twice as likely to have an AMA discharge, and for patients with multiple admissions, rates of acutely painful diagnoses increased with each admission coinciding with a cascading pattern of worsening infectious morbidity over time. Chronic pain diagnoses were inconsistent for those patients with multiple admissions, appearing, for the same patient, in one admission but not others; those with inconsistent documentation of chronic pain were substantially more likely to self-discharge.
PainRelief.com: What should readers take away from your report?
Response: These findings underscore the importance of aggressive and effective pain care in disrupting a process of self-directed discharge, intensifying harm, and preventable financial cost and suffering. Each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Future research should be aimed at evaluating approaches for effective pain management in patients with opioid related disorders. These patients may present with high levels of opioid analgesic tolerance and opioid-induced hyperalgesia, suggesting that non-opioid analgesic approaches may be warranted to effectively manage their pain. Regardless of the specific pain management approach employed, patients with opioid-related disorders should believe that their complaints of pain are taken seriously and managed aggressively to maximize duration of hospital stay.
Citation:
Compton, P., Aronowitz, S.V., Klusaritz, H. et al. Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: a cohort study. Harm Reduct J 18, 131 (2021). https://doi.org/10.1186/s12954-021-00581-6
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PainRelief.com Interview with: Dr Deanne Jenkin PhD UNSW Australia, now Research Fellow at The Daffodil Centre Sydney, Australia
Dr Jenkin
PainRelief.com: What is the background for this study? What are the main findings?
Response: At the time, long-term opioid use for chronic non-cancer pain was increasing and there were signs that their benefit was overestimated whilst the harms were underestimated. Our randomized trial found that after going home from fracture surgery, strong opioids were not better for pain relief compared to a milder, potentially safer opioid alternative.
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, endorese, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. None of the content on PainRelief.com is warranted by the editors or owners of PainRelief.com or Eminent Domains Inc.
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